Process in a vector which is used to increase the yield of protein produced in recombinant protein synthesis is Promoter induction.

Differential RNA processing is responsible for deciding whether an antibody/ immunoglobulin will remain membrane bound or get secreted.

Methods of fusing 2 cells in genetic recombination technique includes fusion mediated by Ethylene glycol, fusion mediated by Electric current and fusion mediated by viral transformation.

2 transgenic plants were genetically engineered using recombinant DNA technology. One plant was transformed using a plasmid vector with GFP (green fluorescent protein) gene and another plant was transformed with Luciferase gene. Then plant with Luciferase gene will grow in dark.

Oprelvekin is used for treatment of Thrombocytopenia secondary to myelosuppressive cancer chemotherapy.

Diuretic should not be used in a patient on Lithium to prevent Lithium toxicity.

Adverse effects of Thalidomide includes teratogenicity, DVT and peripheral neuropathy.

Alkalinization of urine is done during administration of Methotrexate.

Mineralocorticoid receptors are found in colon, hippocampus and kidney.

Pathology

Mitochondria plays a pivotal role in Apoptosis.

Enzymes which may contribute in generating free oxygen radicals within neutrophils for killing intracellular bacteria includes Superoxide dismutase, fenton’s reaction and NADPH oxidase.

Oxidase is responsible for generating ‘oxygen burst’ within neutrophils for killing intracellular bacteria.

Most characteristic feature of acute inflammation is vasodilatation and increased vascular permeability.

In Xanthogranulomatous inflammation foam cells are seen, yellow nodules are seen and multinucleated giant cells are seen.

Factor X is part of both intrinsic and extrinsic pathways, intrinsic pathway can be activated in vitro and calcium is required in several steps of coagulation.

HbH is associated with deletion of 3 alpha genes.

In platelet function defect there is normal platelet count with prolonged bleeding time.

Bernard soulier syndrome aggregation with collagen and ADP is normal, large platelets and thrombocytopenia.

Anti-beta 2 glycoprotein antibody is most frequently seen in antiphospholipid syndrome.

SLE, Grave’s disease and Myasthenia gravis are autoimmune disease.

Necrotizing lymphadenitis is characteristically seen in Kikuchi disease.

Gangliocytoma, Ganglioglioma and Neurocytoma are Neuronal tumors.

Psammoma bodies may be seen in Papillary carcinoma of Thyroid, meningioma and serous cystadenocarcinoma of ovary.

Most commonly used ‘fixative’ in diagnostic pathology is Formaldehyde.

Microbiology

Patient with sign of pneumonia, bacteria obtained from sputum was a gram positive cocci which showed alpha hemolysis on sheep agar. Bile solubility test will help to confirm the diagnosis.

In pneumococcus, capsule aids in virulence, commonest cause of otitis media and respiratory tract of carriers is most important source of infection.

8-year-old child with history of pain and discharge from right ear presents with fever, neck rigidity and a positive Kernig’s sign. Discharge was stained gram stain which revealed gram positive cocci. Most likely organism is Pneumococcus.

Resistance to Methicillin in MRSA is produced as a result of alteration in Penicillin Binding proteins (PBP), resistance may be produced by hyperproduction of beta lactamase and resistance may be missed at incubation temperature of 37 degree C during susceptibility testing.

C. diphtheria may be identified by tests for toxicity, toxin acts by inhibiting protein synthesis and toxin may affect the heart and nerves.

Campylobacter jejuni is commonest agent responsible for campylobacteriosis, poultry is a common source of infection and associated with Guillain Barre Syndrome.

Farmer with painful inguinal lymphadenopathy, h/o fever and flu like symptoms and ulcer on leg. Stain used to detect suspected bipolar stained organism is Wayson’s stain.

Clostridium tetani spores are resistant to heat, primary immunization consists of 3 doses, incubation period is 6-10 days and person to person transmission does not occur in it.

If ovalbumin is injected into a Rabbit, IgE antibodies are likely to be produced initially.

Forensic Medicine

‘Sparrow’s foot’ mark is seen in Windshield Glass injury.

Gunpowder or soot on bloodstained garments can be visualized by Infrared rays.

Markings of Rickshaw tire over body of a child after accident is best defined as Patterned abrasions.

‘Fracture-ala signature’ or signature fracture is Depressed fracture of skull.

Most common injury to child after violent shaking by parent is Subdural hematoma.

Dental numbering is done by FDI two digit system, anatomic and diagrammatic charting and palmer notation.

Yellow phosphorus is a luminous, translucent and waxy poison.

Patient with bluish discolouration of conjunctiva, mucous membrane and nails one hour after ingestion of poison. On examination tachycardia and hypotension seen. Most likely ingested poison is Arsenic.

Ecstasy is commonly used as a Rave drug.

Urinary bladder is presently not being used for organ transplantation.

PSM

Human development index includes Life expectancy at birth, education and GDP.

Case fatality rate is a good index of severity of an acute disease.

Denominator in estimating Maternal mortality rate (MMR) is total number of live births.

Chronic carrier state is seen in Diphtheria, Typhoid and Gonorrhea.

Tetracycline is used in prophylaxis of Cholera.

Vectors may transmit infection by Regurgitation, Rubbing of infected faeces and Contamination with body fluids.

Use of alkaline detergents is a non-deliberate cultural practice leading to anti-mosquito effect.

Factors responsible for resurgence of malaria includes Drug resistance in parasite, insecticide resistance in vectors and antigenic mutations in parasite.

Musca domestica, Xenopsylla species and Anopheles species have developed resistance to DDT but Phlebotomus species has not.

Yellow fever is an Arboviral disease which is not found in India.

In Japanese encephalitis 2-3 cases per village may suggest an epidemic, children are more frequently affected than adults and ratio of inapparent to apparent infections is >100:1.

Yaws is causd by Treponema paertunae, it is transmitted non-venereally and secondary yaws can involve bone.

According to Mc keown’s theory, reduction in mortality from TB was a consequence of Social and environmental factors.

Phosphatase test is performed to assess the efficiency of pasteurization.

Orthotolidine test is used for detecting Chlorine.

Mercury vapor is least likely cause of indoor air pollution.

Dental caries does not have a national Screening/ Control programme.

Reforms proposed by World Health Report (2008) includes Service reforms, leadership reforms and Policy reforms.

Direct standardization is used to compare the mortality rates between 2 countries because of difference in Age distribution.

If a village is divided into 5 relevant subgroups for the purpose of a survey and individuals from each subgroup are then selected randomly then this type of sampling is Stratified sampling.

If a region is divided into 50 villages for the purpose of a survey and 10 villages are then selected randomly for the purpose of a study then his type of sampling is termed as Cluster sampling.

Punnett square is used to predict genotype of offspring.

If an investigator observes that 5 independent risk factors influence the occurrence of a disease, then multiple logistic regression should be applied to assess the relationship between these 5 risk factors and the occurrence of disease.

Pearson’s coefficient of skewness is defined as (Mean-Mode)/SD.

Human anatomical waste is disposed in a Yellow bag, contents from a Red bag may be a source of contamination and block bags are used for disposal of ash from incineration.

Plague (Yersinia pestis) carries the highest potential for use as a biological weapon for microbial bioterrorism. Smallpox (Variola major) and Botulism (Cl. botulinum) also has potential for use as a biological weapon for microbial bioterrorism.

Small cell carcinoma is most commonly associated with superior vena cava syndrome.

Pulmonary fibrosis is associated with the use of Bleomycin.

Acid base status of a patient reveals pH of 7.46 and pCO2 of 30 mm Hg. So patient has a partially compensated primary Respiratory alkalosis.

Sterile Pyuria is characteristically seen in Renal tuberculosis.

For a woman with UTI, findings on a midstream urine sample which supports the diagnosis of ‘Uncomplicated acute cystitis’ includes positive nitrite test, detection of 1 bacteria/field on gram stain and >10 WBC/HPF.

Radiopaque stones is a contraindication or medical management of Gallstones.

35-year-old woman with proximal weakness of muscles, ptosis and easy fatigability. Most sensitive test to suggest the diagnosis is Single fiber EMG.

NARP syndrome is a type of Mitochondrial function disorder.

Surgery

Ranula is a cystic swelling in the floor of mouth.

A well differentiated follicular carcinoma of thyroid can be best differentiated from a follicular adenoma by Vascular invasion.

Multiple cutaneous sebaceous adenomas are seen in Muir Torre syndrome.

30-year-old with epigastric pain radiating to back that wakes him up at night and is relieved by consuming food. He gives h/o similar episodes which was diagnosed as perforated duodenal ulcer and was treated with omental patch surgery on 2 occasions. Pain before and after surgery has been controlled with PPI and analgesics. Likely diagnosis is Duodenal ulcer.

Gastric carcinoma are often associated with Hypochlorhydria/ Achlorhydria.

50-year-old woman with 2 year h/o recurrent abdominal pain with radiation to her back, pain is severe in intensity and refractory to simple analgesics. USG and CECT confirmed the diagnosis and showed dilated pancreatic duct. Most likely recommended surgical procedure of choice is longitudinal pancreaticojejunostomy.

Patient with stab injury to anterior abdomen with tag of omentum protruding through abdominal wall near umbilicus and he was hemodynamically stable with no signs of peritonitis. Initial management should be CECT abdomen.

Patient with abdominal injury and signs of peritonitis and shock. Airway and breathing were secured and IV fluids were started with 2 large bore cannulas. Next line of management should be exploratory laparotomy under GA.

Portion of liver to the left of the attachment of falciform ligament is segment 2 and 3.

Renal calculi associated with proteus infection is Triple phosphate.

Most common cause of delayed urinary tract obstructive symptoms after TURP is bladder neck stenosis.

55-year-old smoker with h/o 5 episodes of macroscopic hematuria each lasting for about 4-5 days in the past five years. Investigation to be performed to evaluate suspected diagnosis is urine microscopy and cytology.

40-year-old patient with single kidney presents with solitary exophytic mass of 4 cm localized at its lower pole. Best recommended management is partial nephrectomy.

Woman with hematuria was found to have Stage II Transitional Cell Carcinoma of bladder. Then there are 70% chances of requiring cystectomy in 5 years after TUR.

Surgery for undescended testis is recommended at 6 months of age and should be done before 12 months of age.

5-year-old child with ballooning of prepuce after micturition. Examination revealed preputial adhesions. Best treatment would be Circumcision.

Fibers are not included in Total Parenteral Nutrition.

Patient with head injury opens eyes to painful stimulus and uses inappropriate words and localizes pain. GCS score in this patient is 10.

Pediatrics

Premature baby born at 33 weeks of gestation with a birth weight of 1500 gm has stable vitals. Initial feeding method of choice is Orogastric tube/ Alternate oral route.

Most important determinant of prognosis in neonatal Congenital Diaphragmatic hernia (CDH) is pulmonary hypertension and least important prognostic factor is delay in emergent surgery.

Infant of diabetic mother with weight 3.8 kg presented with seizures after 16 hours of birth. Most likely cause is Hypoglycemia.

Pentalogy of Fallot includes Atrial septal defect (ASD).

Enlarged left atrium on X-ray chest can differentiate an ASD from an VSD.

Previously healthy infant with recurrent episodes of abdominal pain, passing altered stool after episodes of pain but no h/o vomiting or bleeding per rectum. Most likely diagnosis is Intussusception.

12-year-old boy with hematemesis, melena and mild splenomegaly. No obvious jaundice or ascites. Most likely diagnosis is EHPVO.

Child with fever and mild respiratory distress was started on oral antibiotics and showed initial improvement but later deteriorated again with fever, wheeze and exaggerated breathlessness. Radiographs of chest showed hyperlucency and pulmonary function tests showed an obstructive pattern. Most probable diagnosis is Bronchiolitis Obliterans.

Most common tumor associated with neurofibromatosis-I (NF-I) in a child is Juvenile Myelomonocytic Leukemia (JMML).

Most common cause of meningoencephalitis in children is Enterovirus.

6-year-old child managed by complete surgical removal of craniopharyngioma developed endocrinopathies. Hormone which should be replaced first is Hydrocortisone.

For a child with recurrent bouts of severe cough followed by an audible whoop. Best type of specimen to isolate the organism and confirm diagnosis is Nasopharyngeal swab.

Previously healthy 8-year-old boy presented with high grade fever, arthralgia, pruritic erythematous rash and lymphadenopathy. He has completed 8 out of 10 days course of cefaclor for URTI. Initially suspected condition is Type III hypersensitivity reaction and most likely diagnosis is Serum sickness like illness (SSLI).

Right sided isomerism is associated with Asplenia.

Burn area corresponding to the size of palm of a 5-year-old is 1% BSA.

Patient with flashing light, sudden floaters and perception of a curtain falling in front of eye. Most likely diagnosis is Rhegmatogenous retinal detachment.

Young patient with loss of central vision, no obvious family history, ERG and EOG normal. Most likely diagnosis is Stargardt’s disease. If in this patient EOG is abnormal then it is Best’s Vitelliform dystrophy.

Agents used in treatment of Diabetic macular edema/retinopathy includes Ruboxistaurin, Pyridazinones and benfotiamine.

Most common cause of bilateral proptosis in children is Chloroma (Leukemia).

Most common malignant orbital tumor in children is Rhabdomyosarcoma.

5-year-old with leukocoria in right eye which is diagnosed as diffuse retinoblastoma involving entire globe. Left eye has a small 2-3 mm tumor in periphery. Ideal management of this patient is Enucleation of right eye and focal therapy of the left eye.

Young boy with decreased vision, 6 months after hit by tennis ball. Finding on optical examination suggestive of blunt injury to eye is Vitreous base detachment.

ENT

NaF in otosclerosis acts by inhibiting proteolytic enzymes in cochlea, is contraindicated in chronic nephritis and is indicated in patients with a positive Schwartze sign.

Pain sensations from ethmoidal sinus are carried by Nasolacrimal nerve.

Onodi cells and Haller cells are seen in relation to Optic nerve and floor of orbit respectively.

Orthopaedics

Main blood supply to the head and neck of femur comes from Medial circumflex femoral artery.

65-year-old woman with long h/o pain and swelling in her right knee and pain significantly interfering with her daily activities.Radiological evaluation shows Grade III osteoarthritis. REcommended line of management is Total knee replacement.

Athletic teenage girl complains of anterior knee pain on climbing stairs and on getting up after prolonged sitting. Most likely diagnosis is Chondromalacia Patellae.

50-year-old woman sprained her ankle 2 months back from which she made a steady recovery. 2 months after injury she gradually developed severe pain in her right ankle with significant limitation of ankle movement. Clinical examination reveals edema and shiny skin. Likely diagnosis in Complex regional pain syndrome Type I (CRPS I).

Most common nerve involved in supracondylar fracture of humerus is Anterior interosseous nerve.

6-year-old boy with painful limp, tenderness in femoral triangle and some limitation of hip movements. X-ray was normal. Next actions should be a MRI scan.

Blount’s disease is characterized by Genu varum and is also associated with Genu recurvatum and internal tibial torsion.

In low radial nerve palsy there is loss of nerve supply to extensor carpi radialis brevis and extensor pollicis brevis and loss of sensation over 1st dorsal web spaces.

Skin

Cicatrising alopecia with perifollicular blue-gray patches is most whitish lesions in buccal mucosa.

Erythema nodosum is seen in pregnancy, TB and SLE.

Young woman with h/o fever and nodular lesion over shin. Histopathology reveals foamy histiocytes with neutrophilic infiltration. No evidence of vasculitis. Most probable diagnosis is Erythema nodosum.

Child with fever presents with multiple tender erythematous skin lesions. On microscopy skin lesions are seen to have neutrophilic infiltration in dermis. Diagnosis is Sweet syndrome.

Young man with maculopapular rash 2 weeks after healing of a painless genital ulcer. Most likely etiological agent is Treponema pallidum.

Anaesthetic agent with vasoconstrictor drug is contraindicated in Finger block.

IV regional anaesthesia should be avoided in sickle cell disease.

Spinal anaesthesia is given at L2-L4.

Sudden aphonia and loss of consciousness during spinal anaesthesia is due to Vasovagal attack.

40-year-old woman after undergoing surgery told anaesthetist that she was aware of preoperative events. Individual intraoperative awareness is evaluated by Bi-spectral imaging.

Rise in end tidal CO2 during thyroid surgery can be due to malignant hyperthermia, thyroid storm and neuroleptic malignant syndrome.

If fire breaks out during laser vocal cord surgery, things to be done includes pouring sterile water, removing endotracheal tube and treatment with steroid and antibiotics but thing not to be done is % oxygen after discontinuing anaesthetic gases.

Radiology

For contrast in radiography, ionic monomers have 3 iodine atoms per 2 particles in solution.

Low osmolar contrast is preferred in a patient with decreased renal function to avoid contrast nephropathy.

Consolidation of left upper lobe (posterior part) is likely to obliterate the Aortic knuckles on X-ray chest.

Objective sign of identifying pulmonary plethora in a chest radiography is diameter of descending right pulmonary artery >16 mm.

Best investigation for bone metastasis is Bone scan.

CT is least accurate diagnosis of Gallstones.

Dose of radiation during whole body exposure that leads to Hematological syndrome is 2 Gy.

Psychiatry

40-year-old woman with h/o depressed mood, loss of appetite insomnia and no interest in surroundings for past 1 year. Symptoms followed soon after a business loss. Management is antidepressants treatment based on side effect profile of drugs.

Antidepressant drug used in nocturnal enuresis is Imipramine.

Most common cause of premature death in schizophrenia is Suicide.

Patient with acute psychosis, on haloperidol 20 mg/day for last 2 days has an episode characterized by tongue protrusion, oculogyric crisis, torticollis and abnormal posture of limbs and trunk without loss of consciousness for 20 minutes before presenting to emergency. This improved within a few minutes after administration of diphenhydramine. Most likely diagnosis is Acute dystonia.

Agents used in treatment of alcohol dependence includes Acamprosate, Naltrexone and Disulfiram.

Chronic smoker taking 20 cigarettes/day has developed chronic cough. His family suggested quitting cigarettes. He is ready to quit but thinks that quitting will make him irritable. Stage of behaviour change is Contemplation and cost analysis.

Imbecile has intellectual capacity equivalent to child of 3-7 year of age, impaired self-care and condition usually congenital or acquired at an early age.

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